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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: � <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: 3 /,a/,ff JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN - FEE DUE: <br /> Area Code -Telephone Number: 207-/ EXP.DATE: DRIVEWAYS: <br /> STREET: 00\C�i 1'Z <br /> SITE INFORMATION: AREA: --QUAD _ <br /> Parcel Owner's Name: X// ZP TYPE: \J <br /> Site Address: 4--,v, ,Q4 FORMS: <br /> City,State,Zip Code: l� NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zi Code: 4 3 INDUSTRIAL: RIW <br /> Area Code -Telephone Number: ri,- - 341,W RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> undersigned hereby applies for permissp to excavate,construct and/or otherwise encroach on County Highway Rht-of-Way on the <br /> side of A approximately 30C3' feet/mile 1-,- <br /> of SA VA by installing <br /> ��— — <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> ILI <br /> \/,,Will this project be self-installed? -ES NO Contractor's License <br /> M:\CENTRALSERVICES\CLERICAL\PU&SV.WKWASTER.PS\ENCROACHMENT PERMIT DRIVEWAYMOC (09113) Page 1 of 2 <br />